慢性透析患者COVID-19的临床表现和结局:来自希腊的单中心经验

D. Bacharaki, Minas Karagiannis, Aggeliki Sardeli, Panagiotis N Giannakopoulos, N. Tziolos, Vasiliki Zoi, Nikitas Piliouras, N. Arkoudis, N. Oikonomopoulos, K. Tzannis, D. Kavatha, A. Antoniadou, D. Vlahakos, S. Lionaki
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引用次数: 2

摘要

2019冠状病毒病(COVID-19)仍然是一种具有威胁性的大流行,特别是在弱势患者中。维持性血液透析(MHD)患者的COVID-19发病率和死亡率被认为比一般人群更差,但在欧洲各大洲和国家有所不同。目的回顾性观察性单中心研究希腊MHD合并COVID-19住院患者的临床过程和结局。方法将大流行期间因COVID-19住院的MHD患者的临床、实验室和放射学数据与临床结果相关联。实时聚合酶链反应证实诊断。结果确定为幸存者与非幸存者以及“进展者”(因COVID-19肺炎恶化而需要补充氧气的人)与“非进展者”。结果32例患者(男性17例),中位年龄75.5 (IQR: 58.5-82)岁。其中12人经筛查确诊,20人有相关症状。根据世界卫生组织(WHO)评分,入院时病情轻重为轻度16例,中度13例,重度3例。24例胸部CT示1-10%浸润。在纳入的患者中记录了13名“进展者”。病死率为5/32(15.6%)。不论合并症和性别,“进展者”中有3人死亡,“非进展者”中有2人死亡。入院时死亡率的预测因素包括虚弱指数、胸部CT表现、WHO严重程度评分,以及此后血清LDH和d -二聚体的升高和血清白蛋白的降低。成为“进展”的预测因素包括中性粒细胞数量和中性粒细胞/淋巴细胞比例的增加。结论与普通人群不同,MHD患者似乎具有更高的COVID-19死亡率。入院时和随访期间的某些实验室参数可能有助于患者的风险分层和管理。
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Clinical presentation and outcomes of chronic dialysis patients with COVID-19: A single center experience from Greece
BACKGROUND Coronavirus disease 2019 (COVID-19) is still a menacing pandemic, especially in vulnerable patients. Morbidity and mortality from COVID-19 in maintenance hemodialysis (MHD) patients are considered worse than those in the general population, but vary across continents and countries in Europe. AIM To describe the clinical course and outcomes of hospitalized MHD patients with COVID-19 in a retrospective observational single center study in Greece. METHODS We correlated clinical, laboratory, and radiological data with the clinical outcomes of MHD patients hospitalized with COVID-19 during the pandemic. The diagnosis was confirmed by real-time polymerase chain reaction. Outcome was determined as survivors vs non-survivors and “progressors” (those requiring oxygen supplementation because of COVID-19 pneumonia worsening) vs “non-progressors”. RESULTS We studied 32 patients (17 males), with a median age of 75.5 (IQR: 58.5-82) years old. Of those, 12 were diagnosed upon screening and 20 with related symptoms. According to the World Health Organization (WHO) score, the severity on admission was mild disease in 16, moderate in 13, and severe in 3 cases. Chest computed tomography (CT) showed 1-10% infiltrates in 24 patients. Thirteen “progressors” were recorded among included patients. The case fatality rate was 5/32 (15.6%). Three deaths occurred among “progressors” and two in “non-progressors”, irrespective of co-morbidities and gender. Predictors of mortality on admission included frailty index, chest CT findings, WHO severity score, and thereafter the increasing values of serum LDH and D-dimers and decreasing serum albumin. Predictors of becoming a “progressor” included increasing number of neutrophils and neutrophils/lymphocytes ratio. CONCLUSION Patients on MHD seem to be at higher risk of COVID-19 mortality, distinct from the general population. Certain laboratory parameters on admission and during follow-up may be helpful in risk stratification and management of patients.
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